US20210169493A1 - Surgical clip applier with articulating joint path for surgical clips - Google Patents

Abstract

A surgical clip applier includes a drive housing, an elongate shaft extending distally from the drive housing, and an end effector arranged at a distal end of the shaft. The end effector includes first and second jaw members, a cam slidably engageable with the first and second jaw members, and an actuation cable extending from the drive housing and operatively coupled to the cam. An articulation joint interposes the end effector and the shaft and includes a distal clevis coupled to the end effector, a proximal clevis coupled to a distal end of the shaft, and a spacer interposing the distal and proximal clevises. Longitudinal movement of the actuation cable moves the cam distally to collapse the first and jaw members.

Description

BACKGROUND
• Minimally invasive surgical (MIS) tools and procedures are often preferred over traditional open surgical approaches due to their propensity toward reducing post-operative recovery time and leaving minimal scarring. Endoscopic surgery is one type of MIS procedure in which a surgical tool operably connected to an elongate shaft is introduced into the body of a patient through a natural bodily orifice. Laparoscopic surgery is a related type of MIS procedure in which a small incision is formed in the abdomen of a patient and a trocar is inserted through the incision to form a surgical access pathway for a surgical tool and elongate shaft. Once located within the abdomen, the surgical tool engages and/or treats tissue in a number of ways to achieve a diagnostic or therapeutic effect. Manipulation and engagement of the surgical tool may take place via various components passing through the elongate shaft.
• One surgical instrument commonly used with a trocar is a surgical clip applier, which can be used to ligate blood vessels, ducts, shunts, or portions of body tissue during surgery. Traditional surgical clip appliers have a handle and an elongate shaft extending from the handle. A pair of movable opposed jaws is positioned at the end of the elongate shaft for holding and forming a surgical clip or “ligation clip” therebetween. In operation, a user (e.g., a surgeon or clinician) positions the jaws around the vessel or duct and squeezes a trigger on the handle to close the jaws and thereby collapse the surgical clip over the vessel.
• More recently, however, robotic systems have been developed to assist in MIS procedures. Instead of directly engaging a surgical instrument, users are now able to manipulate and engage surgical instruments via an electronic interface communicatively coupled to a robotic manipulator. With the advances of robotic surgery, a user need not even be in the operating room with the patient during the surgery.
• Robotic surgical systems are also now capable of utilizing robotically controlled clip appliers. Such clip appliers include features for robotically feeding and forming surgical clips. Advances and improvements to the methods and devices for applying surgical clips to vessels, ducts, shunts, etc. is continuously in demand to make the process more efficient and safe.
BRIEF DESCRIPTION OF THE DRAWINGS
• The following figures are included to illustrate certain aspects of the present disclosure, and should not be viewed as exclusive embodiments. The subject matter disclosed is capable of considerable modifications, alterations, combinations, and equivalents in form and function, without departing from the scope of this disclosure.
• FIG. 1 is a block diagram of an example robotic surgical system that may incorporate some or all of the principles of the present disclosure.
• FIG. 2 is an isometric top view of an example surgical tool that may incorporate some or all of the principles of the present disclosure.
• FIG. 3 is an isometric bottom view of the surgical tool ofFIG. 2.
• FIG. 4 is an exploded view of the elongate shaft and the end effector of the surgical tool ofFIGS. 2 and 3.
• FIG. 5 is an exposed isometric view of the surgical tool ofFIG. 2.
• FIG. 6 is a side view of an example surgical tool that may incorporate some or all of the principles of the present disclosure.
• FIG. 7 illustrates potential degrees of freedom in which the wrist of
• FIG. 1 may be able to articulate (pivot).
• FIG. 8 is an enlarged isometric view of the distal end of the surgical tool ofFIG. 6.
• FIG. 9 is a bottom view of the drive housing of the surgical tool ofFIG. 6.
• FIG. 10 is an isometric exposed view of the interior of the drive housing of the surgical tool ofFIG. 6.
• FIG. 11A is an isometric view of another example embodiment of the surgical tool ofFIG. 6.
• FIG. 11B is an exploded view of the articulation joint ofFIG. 11A.
• FIG. 11C is a cross-sectional side view of the assembled articulation joint ofFIG. 11A in an unarticulated state.
• FIG. 11D is a cross-sectional side view of the assembled articulation joint ofFIG. 11A in an articulated state.
• FIG. 12 is a cross-sectional end view of a portion of the articulation joint ofFIGS. 11A-11D.
• FIGS. 13A-13E are cross-sectional top views of the articulation joint ofFIG. 12 taken along the indicated lines.
• FIG. 14A is a cross-sectional side view of another example articulation joint.
• FIG. 14B is a cross-sectional side view of the articulation joint ofFIG. 14B in an articulated state.
• FIG. 15A is a side view of another example articulation joint.
• FIG. 15B is a shortened side view of at least a portion of the articulation joint ofFIG. 15A.
DETAILED DESCRIPTION
• The present disclosure is related to surgical systems and, more particularly, to surgical clip appliers having an articulation joint made up of a flexible shaft length that feeds surgical clips therethrough and to jaws for crimping.
• Embodiments discussed herein describe improvements to articulable surgical clip appliers. The surgical clip appliers described herein may include a drive housing, an elongate shaft that extends distally from the drive housing, an end effector arranged at a distal end of the elongate shaft and including first and second jaw members. An articulation joint may interpose the end effector and the elongate shaft, and may comprise a flexible shaft length articulable in a plane of motion. A lumen is defined within the flexible shaft length and extends between the ends of the flexible shaft length. A clip track is provided within the lumen and extending at least partially between the ends to guide surgical clips through the articulation joint. The clip track may be configured to positively engage the surgical clips throughout the path, and the surgical clips may be able to slidably translate through the articulation joint without bending or pre-forming.
• FIG. 1 is a block diagram of an example roboticsurgical system100 that may incorporate some or all of the principles of the present disclosure. As illustrated, thesystem100 can include at least onemaster controller102aand at least onearm cart104. Thearm cart104 may be mechanically and/or electrically coupled to a robotic manipulator and, more particularly, to one or morerobotic arms106 or “tool drivers”. Eachrobotic arm106 may include and otherwise provide a location for mounting one or more surgical tools orinstruments108 for performing various surgical tasks on apatient110. Operation of therobotic arms106 andinstruments108 may be directed by aclinician112a(e.g., a surgeon) from themaster controller102a.
• In some embodiments, asecond master controller102b(shown in dashed lines) operated by asecond clinician112bmay also direct operation of therobotic arms106 andinstruments108 in conjunction with thefirst clinician112a.In such embodiments, for example, eachclinician102a,bmay control differentrobotic arms106 or, in some cases, complete control of therobotic arms106 may be passed between theclinicians102a,b.In some embodiments, additional arm carts (not shown) having additional robotic arms (not shown) may be utilized during surgery on apatient110, and these additional robotic arms may be controlled by one or more of themaster controllers102a,b.
• Thearm cart104 and themaster controllers102a,bmay be in communication with one another via acommunications link114, which may be any type of wired or wireless telecommunications means configured to carry a variety of communication signals (e.g., electrical, optical, infrared, etc.) according to any communications protocol.
• Themaster controllers102a,bgenerally include one or more physical controllers that can be grasped by theclinicians112a,band manipulated in space while the surgeon views the procedure via a stereo display. The physical controllers generally comprise manual input devices movable in multiple degrees of freedom, and which often include an actuatable handle for actuating the surgical instrument(s)108, for example, for opening and closing opposing jaws, applying an electrical potential (current) to an electrode, or the like. Themaster controllers102a,bcan also include an optional feedback meter viewable by theclinicians112a,bvia a display to provide a visual indication of various surgical instrument metrics, such as the amount of force being applied to the surgical instrument (i.e., a cutting instrument or dynamic clamping member).
• Example implementations of robotic surgical systems, such as thesystem100, are disclosed in U.S. Pat. No. 7,524,320, the contents of which are incorporated herein by reference. The various particularities of such devices will not be described in detail herein beyond that which may be necessary to understand the various embodiments and forms of the various embodiments of robotic surgery apparatus, systems, and methods disclosed herein.
• FIG. 2 is an isometric top view of an examplesurgical tool200 that may incorporate some or all of the principles of the present disclosure. Thesurgical tool200 may be the same as or similar to the surgical instrument(s)108 ofFIG. 1 and, therefore, may be used in conjunction with the roboticsurgical system100 ofFIG. 1. Accordingly, thesurgical tool200 may be designed to be releasably coupled to a robotic arm106 (FIG. 1) of a robotic manipulator of the roboticsurgical system100. Full detail and operational description of thesurgical tool200 is provided in U.S. Patent Pub. 2016/0287252, entitled “Clip Applier Adapted for Use with a Surgical Robot,” the contents of which are hereby incorporated by reference in their entirety.
• While thesurgical tool200 is described herein with reference to a robotic surgical system, it is noted that the principles of the present disclosure are equally applicable to non-robotic surgical tools or, more specifically, manually operated surgical tools. Accordingly, the discussion provided herein relating to robotic surgical systems merely encompasses one example application of the presently disclosed inventive concepts.
• As illustrated, thesurgical tool200 can include anelongate shaft202, anend effector204 coupled to the distal end of theshaft202, and adrive housing206 coupled to the proximal end of theshaft202. The terms “proximal” and “distal” are defined herein relative to a robotic surgical system having an interface configured to mechanically and electrically couple the surgical tool200 (e.g., the drive housing206) to a robotic manipulator. The term “proximal” refers to the position of an element closer to the robotic manipulator and the term “distal” refers to the position of an element closer to theend effector204 and thus further away from the robotic manipulator. Moreover, the use of directional terms such as above, below, upper, lower, upward, downward, left, right, and the like are used in relation to the illustrative embodiments as they are depicted in the figures, the upward or upper direction being toward the top of the corresponding figure and the downward or lower direction being toward the bottom of the corresponding figure.
• In applications where thesurgical tool200 is used in conjunction with a robotic surgical system (e.g.,system100 ofFIG. 1), thedrive housing206 can include atool mounting portion208 designed with features that releasably couple thesurgical tool200 to a robotic arm (e.g., therobotic arms106 or “tool drivers” ofFIG. 1) of a robotic manipulator. Thetool mounting portion208 may releasably attach (couple) thedrive housing206 to a tool driver in a variety of ways, such as by clamping thereto, clipping thereto, or slidably mating therewith. In some embodiments, thetool mounting portion208 may include an array of electrical connecting pins, which may be coupled to an electrical connection on the mounting surface of the tool driver. While thetool mounting portion208 is described herein with reference to mechanical, electrical, and magnetic coupling elements, it should be understood that a wide variety of telemetry modalities might be used, including infrared, inductive coupling, or the like.
• FIG. 3 is an isometric bottom view of thesurgical tool200. Thesurgical tool200 further includes aninterface302 that mechanically and electrically couples thetool mounting portion208 to a robotic manipulator. In various embodiments, thetool mounting portion208 includes atool mounting plate304 that operably supports a plurality of drive inputs, shown as afirst drive input306a,asecond drive input306b,and athird drive input306c.While only three drive inputs306a-care shown inFIG. 3, more or less than three may be employed, without departing from the scope of the disclosure.
• In the illustrated embodiment, each drive input306a-ccomprises a rotatable disc configured to align with and couple to a corresponding input actuator (not shown) of a given tool driver. Moreover, each drive input306a-cprovides or defines one or more surface features308 configured to align with mating surface features provided on the corresponding input actuator. The surface features308 can include, for example, various protrusions and/or indentations that facilitate a mating engagement.
• FIG. 4 is an exploded view of one example of theelongate shaft202 and theend effector204 of thesurgical tool200 ofFIGS. 2 and 3, according to one or more embodiments. As illustrated, theshaft202 includes anouter tube402 that houses the various components of theshaft202, which can include ajaw retaining assembly404. Thejaw retaining assembly404 includes ajaw retainer shaft406 with aclip track408 and apush rod channel410 formed thereon. Theend effector204 includes opposingjaws412 that are configured to mate to a distal end of theclip track408.
• Theshaft202 also includes a clip advancing assembly, which, in one example embodiment, can include afeeder shoe414 adapted to be slidably disposed within theclip track408. Thefeeder shoe414 is designed to advance a series ofclips416 positioned within theclip track408, and afeedbar418 is adapted to drive thefeeder shoe414 through theclip track408. Anadvancer assembly420 is adapted to mate to a distal end of thefeedbar418 for advancing a distal-most clip into thejaws412.
• Theshaft202 furthers include a clip forming or camming assembly operable to collapse thejaws412 and thereby crimp (crush) asurgical clip416 positioned between (interposing) thejaws412. The camming assembly includes acam422 that slidably mates to thejaws412, and apush rod424 that moves thecam422 relative to thejaws412 to collapse thejaws412. Atissue stop426 can mate to a distal end of theclip track408 to help position thejaws412 relative to a surgical site.
• Thejaw retainer shaft406 is extendable within and couples to theouter tube402 at aproximal end428a,and itsdistal end428bis adapted to mate with thejaws412. Thepush rod channel410 formed on thejaw retainer shaft406 may be configured to slidably receive thepush rod424, which is used to advance thecam422 over thejaws412. Theclip track408 extends distally beyond thedistal end428bof thejaw retainer shaft406 to allow a distal end of theclip track408 to be substantially aligned with thejaws412.
• Theclip track408 can includeseveral openings430 formed therein for receiving an upper or “superior”tang432aformed on thefeeder shoe414 adapted to be disposed within theclip track408. Theclip track408 can also include astop tang434 formed thereon that is effective to be engaged by a corresponding stop tang formed on thefeeder shoe414 to prevent movement of thefeeder shoe414 beyond a distal-most position. To facilitate proximal movement of thefeeder shoe414 within theclip track408, thefeeder shoe414 can also include a lower or “inferior”tang432bformed on the underside thereof for allowing thefeeder shoe414 to be engaged by thefeedbar418 as thefeedbar418 is moved distally. In use, each time thefeedbar418 is moved distally, a detent formed in thefeedbar418 engages theinferior tang432band moves thefeeder shoe414 distally a predetermined distance within theclip track408. Thefeedbar418 can then be moved proximally to return to its initial position, and the angle of theinferior tang432ballows theinferior tang432bto slide into the next detent formed in thefeedbar418.
• Thejaws412 include first and second opposed jaw members that are movable (collapsible) relative to one another and are configured to receive a surgical clip from the series ofclips416 therebetween. The jaw members can each include a groove formed on opposed inner surfaces thereof for receiving the legs of asurgical clip416 in alignment with the jaw members. In the illustrated embodiment, the jaw members are biased to an open position and a force is required to urge the jaw members toward one another to crimp theinterposing clip416. The jaw members can also each include a cam track formed thereon for allowing thecam422 to slidably engage and move the jaw members toward one another. Aproximal end436aof thecam422 is matable with adistal end438aof thepush rod424, and adistal end436bof thecam422 is adapted to engage and actuate thejaws412. Theproximal end438bof thepush rod424 is matable with a closure link assembly associated with thedrive housing206 for moving thepush rod424 and thecam422 relative to thejaws412.
• Thedistal end436bof thecam422 includes a camming channel or tapering recess formed therein for slidably receiving corresponding cam tracks provided by the jaw members. In operation, thecam422 is advanced from a proximal position, in which the jaw members are spaced apart from one another, to a distal position, where the jaw members are collapsed to a closed position. As thecam422 is advanced over the jaw members, the tapering recess at thedistal end436bserves to push the jaw members toward one another, thereby crimping asurgical clip416 disposed therebetween.
• FIG. 5 is an exposed isometric view of thesurgical tool200 ofFIG. 2, according to one or more embodiments. The shroud or covering of thedrive housing206 has been removed to reveal the internal component parts. As illustrated, thesurgical tool200 may include afirst drive gear502a,asecond drive gear502b,and athird drive gear502c.Thefirst drive gear502amay be operatively coupled to (or extend from) thefirst drive input306a(FIG. 3) such that actuation of thefirst drive input306acorrespondingly rotates thefirst drive gear502a.Similarly, the second and third drive gears502b,cmay be operatively coupled to (or extend from) the second andthird drive inputs306b,c(FIG. 3), respectively, such that actuation of the second andthird drive inputs306b,ccorrespondingly rotates the second and third drive gears502b,c,respectively.
• Thefirst drive gear502amay be configured to intermesh with a first drivengear504a,which is operatively coupled to theshaft202. In the illustrated embodiment, the drivengear504acomprises a helical gear. In operation, rotation of thefirst drive gear502aabout a first axis correspondingly rotates the first drivengear504aabout a second axis orthogonal to the first axis to control rotation of theshaft202 in clockwise and counter-clockwise directions based on the rotational direction of thefirst drive gear502a.
• Thesecond drive gear502bmay be configured to intermesh with a second drivengear504b(partially visible inFIG. 5), and thethird drive gear502cmay be configured to intermesh with a third drivengear504c.In the illustrated embodiment, the second and third drive and drivengears502b,c,504b,ccomprise corresponding rack and pinion interfaces, where the drivengears504b,ccomprise the rack and the drive gears502b,ccomprise the pinion. Independent rotation of the second and third drive gears502b,cwill cause the second and third drivengears504b,c,respectively, to translate linearly relative to (independent of) one another.
• In at least one embodiment, actuation (rotation) of thethird drive gear502cwill result in a surgical clip416 (FIG. 4) being fed into thejaws412. More particularly, the third drivengear504cmay be operatively coupled to the feedbar418 (FIG. 4) and, upon rotation of thethird drive gear502cin a first angular direction, the third drivengear504cwill advance distally and correspondingly advance the feedbar418 a sufficient distance to fully advance a surgical clip into thejaws412. Rotation of thethird drive gear502cmay be precisely controlled by an electrical and software interface to deliver the exact linear travel to the third drivengear504cnecessary to feed aclip416 into thejaws412.
• Upon delivery of a clip into thejaws412, or after a predetermined amount of rotation of thethird drive gear502c,rotation of thethird drive gear502cis reversed in a second angular direction to move the third drivengear504clinearly in a proximal direction, which correspondingly moves thefeedbar418 proximally. This process may be repeated several times to accommodate a predetermined number of clips residing in theshaft202.
• Actuation of thesecond drive gear502bcauses thejaws412 to close or collapse to crimp a surgical clip. More particularly, the second drivengear504bmay be coupled to theproximal end438b(FIG. 4) of the push rod424 (FIG. 4) and, upon actuation of thesecond drive gear502bin a first angular direction, the second drivengear504bwill be advanced linearly in a distal direction and correspondingly drive thepush rod424 distally, which drives thecam422 over thejaws412 to collapse the jaw members and crimp a surgical clip positioned in thejaws412. Once a surgical clip is successfully deployed, rotation of thesecond drive gear502bis reversed in the opposite angular direction to move the second drivengear504bin a proximal direction, which correspondingly moves thepush rod424 and thecam422 proximally and permits thejaws412 to open once again.
• The processes of delivering a surgical clip into thejaws412 and collapsing thejaws412 to crimp the surgical clip are not limited to the actuation mechanisms and structures described herein. In alternative embodiments, for example, the second and third drivengears504b,cmay instead comprise capstan pulleys configured to route and translate drive cables within theshaft202. In such embodiments, the drive cables may be operatively coupled to one or more lead screws or other types of rotating members positioned within theshaft202 near the distal end and capable of advancing thefeedbar418 to deliver a surgical clip into thejaws412 and advancing thecam422 to collapse thejaws412 and crimp the surgical clip.
• FIG. 6 is an isometric top view of another examplesurgical tool600 that may incorporate some or all of the principles of the present disclosure. Similar to thesurgical tool200 ofFIG. 2, thesurgical tool600 may be used in conjunction with the roboticsurgical system100 ofFIG. 1. As illustrated, thesurgical tool600 includes anelongate shaft602, anend effector604 positioned at the distal end of theshaft602, an articulation joint606 (alternately referred to as a “articulable wrist joint”) that couples theend effector604 to the distal end of theshaft602, and adrive housing608 coupled to the proximal end of theshaft602. In some embodiments, theshaft602, and hence theend effector604 coupled thereto, is configured to rotate about a longitudinal axis A₁.
• In the illustrated embodiment, theend effector604 comprises a clip applier that includes opposingjaw members610,612 configured to collapse toward one another to crimp a surgical clip. The articulation joint606 facilitates pivoting movement of theend effector604 relative to theshaft602 to position theend effector604 at desired orientations and locations relative to a surgical site. Thehousing608 includes (contains) various actuation mechanisms designed to control articulation at the articulation joint606 and operation of theend effector604.
• FIG. 7 illustrates the potential degrees of freedom in which the articulation joint606 may be able to articulate (pivot). The degrees of freedom of the articulation joint606 are represented by three translational variables (i.e., surge, heave, and sway), and by three rotational variables (i.e., Euler angles or roll, pitch, and yaw). The translational and rotational variables describe the position and orientation of a component of a surgical system (e.g., the end effector604) with respect to a given reference Cartesian frame. As depicted inFIG. 7, “surge” refers to forward and backward translational movement, “heave” refers to translational movement up and down, and “sway” refers to translational movement left and right. With regard to the rotational terms, “roll” refers to tilting side to side, “pitch” refers to tilting forward and backward, and “yaw” refers to turning left and right.
• The pivoting motion can include pitch movement about a first axis of the articulation joint606 (e.g., X-axis), yaw movement about a second axis of the articulation joint606 (e.g., Y-axis), and combinations thereof to allow for 360° rotational movement of theend effector604 about the articulation joint606. In other applications, the pivoting motion can be limited to movement in a single plane, e.g., only pitch movement about the first axis of the articulation joint606 or only yaw movement about the second axis of the articulation joint606, such that theend effector604 moves only in a single plane.
• Referring again toFIG. 6, thesurgical tool600 includes a plurality of drive cables (generally obscured inFIG. 6) that form part of a cable driven motion system configured to facilitate operation and articulation (movement) of theend effector604 relative to theshaft602. For example, selectively moving the drive cables can actuate theend effector604 and thereby collapse thejaw members610,612 toward each other. Moreover, moving the drive cables can also move theend effector604 between an unarticulated position and an articulated position. Theend effector604 is depicted inFIG. 6 in the unarticulated position where a longitudinal axis A₂of theend effector604 is substantially aligned with the longitudinal axis A₁of theshaft602, such that theend effector604 is at a substantially zero angle relative to theshaft602. In the articulated position, the longitudinal axes A₁, A₂would be angularly offset from each other such that theend effector604 is at a non-zero angle relative to theshaft602.
• FIG. 8 is an enlarged isometric view of the distal end of thesurgical tool600 ofFIG. 6. More specifically,FIG. 8 depicts an enlarged and partially exploded view of theend effector604 and the articulation joint606. The articulation joint606 operatively couples theend effector604 to theshaft602. To accomplish this, the articulation joint606 includes adistal clevis802a,aproximal clevis802b,and aspacer803 interposing the distal andproximal clevises802a,b.
• Theend effector604 is coupled to thedistal clevis802aand thedistal clevis802ais rotatably mounted to thespacer803 at afirst axle804a.Thespacer803 is rotatably mounted to theproximal clevis802bat asecond axle804band theproximal clevis802bis coupled to adistal end806 of theshaft602.
• The articulation joint606 provides a first pivot axis P₁that extends through thefirst axle804aand a second pivot axis P₂that extends through thesecond axle804b.The first pivot axis P₁is substantially perpendicular (orthogonal) to the longitudinal axis A₂of theend effector604, and the second pivot axis P₂is substantially perpendicular (orthogonal) to both the longitudinal axis A₂and the first pivot axis P₁. Movement about the first pivot axis P₁provides “yaw” articulation of theend effector604, and movement about the second pivot axis P₂provides “pitch” articulation of theend effector604.
• A plurality ofdrive cables808 extend longitudinally within theshaft602 and pass through thewrist106 to be operatively coupled to theend effector604. Thedrive cables808 form part of the cable driven motion system briefly described above, and may be referred to and otherwise characterized as cables, bands, lines, cords, wires, ropes, strings, twisted strings, elongate members, etc.
• Thedrive cables808 can be made from a variety of materials including, but not limited to, metal (e.g., tungsten, stainless steel, etc.) or a polymer.
• Thedrive cables808 extend proximally from theend effector604 to the drive housing608 (FIG. 6) where they are operatively coupled to various actuation mechanisms or devices housed (contained) therein to facilitate longitudinal movement (translation) of thedrive cables808. Selective actuation of thedrive cables808 causes theend effector604 to articulate (pivot) relative to theshaft602. Moving a givendrive cable808 constitutes applying tension (i.e., pull force) to the givendrive cable808 in a proximal direction, which causes the givendrive cable808 to translate and thereby cause theend effector604 to move (articulate) relative to theshaft602.
• One or more actuation cables810, shown asfirst actuation cables810aandsecond actuation cables810b, may also extend longitudinally within theshaft602 and pass through thewrist106 to be operatively coupled to theend effector604. Theactuation cables810a,bmay be similar to thedrive cables808 and also form part of the cable driven motion system. Selectively actuating theactuation cables810a,bcauses theend effector604 to actuate, such as collapsing the first andsecond jaw members610,612 to crimp a surgical clip (not shown).
• More specifically, theactuation cables810a,bmay be operatively coupled to acam812 that is slidably engageable with thejaw members610,612. One ormore pulleys814 may be used to receive and redirect thefirst actuation cables810afor engagement with thecam812. Longitudinal movement of thefirst actuation cables810acorrespondingly moves thecam812 distally relative to thejaw members610,612. The distal end of thecam812 includes a tapering recess orcamming channel816 formed therein for slidably receiving corresponding cam tracks818 provided by thejaw members610,612. As thecam812 is advanced distally, thecamming channel816 pushes (collapses) thejaw members610,612 toward one another, thereby crimping a surgical clip (not shown) disposed therebetween. Actuation of thesecond actuation cables810b (one shown) pulls thecam812 proximally, thereby allowing thejaw members610,612 to open again to receive another surgical clip.
• Although not expressly depicted inFIG. 8, an assembly including, for example, a feedbar, a feeder shoe, and a clip track may be included at or near theend effector604 to facilitate feeding surgical clips into thejaw members610,612. In some embodiments, the feedbar (or a connecting member) may be flexible and extend through the articulation joint606.
• FIG. 9 is a bottom view of thedrive housing608, according to one or more embodiments. As illustrated, thedrive housing608 may include atool mounting interface902 used to operatively couple thedrive housing608 to a tool driver of a robotic manipulator. Thetool mounting interface902 may mechanically, magnetically, and/or electrically couple thedrive housing608 to a tool driver.
• As illustrated, theinterface902 includes and supports a plurality of drive inputs, shown asdrive inputs906a,906b,906c,906d,906e,and906f.Each drive input906a-fmay comprise a rotatable disc configured to align with and couple to a corresponding input actuator (not shown) of a tool driver. Moreover, each drive input906a-fprovides or defines one or more surface features908 configured to align with mating features provided on the corresponding input actuator. The surface features908 can include, for example, various protrusions and/or indentations that facilitate a mating engagement.
• In some embodiments, actuation of thefirst drive input906amay control rotation of theelongate shaft602 about its longitudinal axis A₁. Depending on the rotational actuation of thefirst drive input906a,theelongate shaft602 may be rotated clockwise or counter-clockwise. In some embodiments, selective actuation of the second andthird drive inputs906b,cmay cause movement (axial translation) of theactuation cables810a,b(FIG. 8), which causes the cam812 (FIG. 8) to move and crimp a surgical clip, as generally described above. In some embodiments, actuation of thefourth drive input906dfeeds a surgical clip into thejaw members610,612 (FIG. 8). In some embodiments, actuation of the fifth andsixth drive inputs906e,fcauses movement (axial translation) of the drive cables808 (FIG. 8), which results in articulation of theend effector604. Each of the drive inputs906a-fmay be actuated based on user inputs communicated to a tool driver coupled to theinterface902, and the user inputs may be received via a computer system incorporated into the robotic surgical system.
• FIG. 10 is an isometric exposed view of the interior of thedrive housing608, according to one or more embodiments. Several component parts that may otherwise be contained within thedrive housing608 are not shown inFIG. 10 to enable discussion of the depicted component parts.
• As illustrated, thedrive housing608 contains afirst capstan1002a,which is operatively coupled to or extends from thefirst drive input906a(FIG. 9) such that actuation of thefirst drive input906aresults in rotation of thefirst capstan1002a.Ahelical drive gear1004 is coupled to or forms part of thefirst capstan1002aand is configured to mesh and interact with a drivengear1006 operatively coupled to theshaft602 such that rotation of the drivengear1006 correspondingly rotates theshaft602. Accordingly, rotation of the helical drive gear1004 (via actuation of thefirst drive input906aofFIG. 9) will drive the drivengear1006 and thereby control rotation of theelongate shaft602 about the longitudinal axis A₁.
• Thedrive housing608 also includes second andthird capstans1002band1002coperatively coupled to or extending from the second andthird drive inputs906b,c(FIG. 9), respectively, such that actuation of the second andthird drive inputs906b,cresults in rotation of the second andthird capstans1002b,c.The second andthird capstans1002b,ccomprise capstan pulleys operatively coupled to theactuation cables810a,b(FIG. 8) such that rotation of a givencapstan1002b,cactuates (longitudinally moves) a corresponding one of theactuation cables810a,b.Accordingly, selective rotation of the second andthird capstans1002b,cvia actuation of the second andthird drive inputs906b,c,respectively, will cause movement (axial translation) of theactuation cables810a,b,which causes the cam812 (FIG. 8) to move and crimp a surgical clip.
• Thedrive housing608 further includes afourth capstan1002d,which is operatively coupled to or extends from thefourth drive input906d(FIG. 9) such that actuation of thefourth drive input906dresults in rotation of thefourth capstan1002d.Aspur gear1008 is coupled to or forms part of thefourth capstan1002dand is configured to mesh and interact with a rack gear (not shown) also contained within thedrive housing608. The rack gear may be operatively coupled to a feedbar (or another connecting member) which facilitates operation of a feeder shoe and associated clip track to feed surgical clips into thejaw members610,612 (FIGS. 6 and 8). Accordingly, rotation of the spur gear1008 (via actuation of thefourth drive input906d) will control the feedbar and thereby control loading of surgical clips into thejaw members610,612 as desired.
• Thedrive housing608 further contains or houses fifth andsixth capstans1002eand1002foperatively coupled to or extending from the fifth andsixth drive inputs906e,f(FIG. 9), respectively, such that actuation of the fifth andsixth drive inputs906e,fresults in rotation of the fifth andsixth capstans1002e,f.The fifth andsixth capstans1002e,fcomprise capstan pulleys operatively coupled to the drive cables808 (FIG. 8) such that rotation of a givencapstan1002e,factuates (longitudinally moves) a corresponding one of theactuation cables808. Accordingly, selective rotation of the fifth andsixth capstans1002e,fvia actuation of the fifth andsixth drive inputs906e,f,respectively, will cause movement (axial translation) of thedrive cables808 and thereby articulate (pivot) theend effector604 relative to theshaft602.
• Thesurgical tools200,600 described herein above may incorporate and facilitate the principles of the present disclosure in improving feeding and/or forming of surgical clips in robotic or non-robotic clip appliers. Moreover, it is contemplated herein to combine some or all of the features of thesurgical tools200,600 to facilitate operation of the embodiments described below. Accordingly, example surgical tools that may incorporate the principles of the present disclosure may include geared actuators, capstan pulley and cable actuators, or any combination thereof, without departing from the scope of the disclosure.
• FIG. 11A is an isometric view of another example embodiment of thesurgical tool600, according to one or more additional embodiments. As illustrated, thearticulation joint606 ofFIG. 6 is replaced with another articulation joint1102. Similar to the articulation joint600, the articulation joint1102 couples theend effector604 to the distal end of theshaft602 and facilitates pivoting movement of theend effector604 relative to theshaft602 to position theend effector604 at desired orientations and locations relative to a surgical site. In the illustrated depiction, the articulation joint1102 has been moved (articulated) to redirect theend effector604 off-axis relative to the longitudinal axis A₁of theshaft602.
• Unlike thearticulation joint600 ofFIG. 6, however, the articulation joint1102 comprises aflexible shaft length1103 and may be characterized or otherwise referred to as a “snake” shaft or “flex” shaft. More specifically, instead of incorporating rotatable axles and pulleys driven by drive cables, the articulation joint1102 may comprise a flexible ormovable shaft length1103 interposing theend effector604 and theshaft602 and capable of articulating (pivoting) in one or more planes based on actuation input derived from thedrive housing608. Moreover, unlike the articulation joint600, the articulation joint1102 may provide or otherwise define a lumen that extends along its axial length and may be configured to house and/or convey surgical clips therethrough to be received at theend effector604 for crimping. Accordingly, surgical clips can be stored within the articulation joint1102 and/or proximal thereto and advanced distally through the articulation joint1102 to be received between thejaw members610,612.
• As used herein, the phrase “flexible shaft length” refers to the elongate body of an end effector articulation joint that is capable of bending or flexing between unarticulated and articulated states and that provides an inner lumen capable of storing surgical clips and/or facilitating distal advancement of surgical clips therethrough. While typical articulation joints have a fixed pivot or center of rotation, the flexible shaft length has a moving center of rotation. In one embodiment, for example, theflexible shaft length1103 may comprise a series of articulation links rotatably coupled to each other and manipulatable with one or more drive cables extending from thedrive housing608. In such embodiments, selective actuation of the drive cable(s) causes theflexible shaft length1103 to articulate (pivot) in one or more planes. In other embodiments, theflexible shaft length1103 may comprise an elongate structure having a plurality of recesses removed along its length to enable the elongate structure to bend or flex in one or more planes upon assuming tensile loads derived from drive cable(s) extending from thedrive housing608. In yet other embodiments, theflexible shaft length1103 may comprise a flexible or bendable shaft section capable of bending or flexing in one or more planes upon assuming tensile loads derived from drive cable(s) extending from thedrive housing608.
• FIG. 11B is an exploded view of an example embodiment of the articulation joint1102, according to one or more embodiments. While the articulation joint1102 is described herein with respect to a particular snake shaft or flex shaft design, it will be appreciated that the articulation joint1102 may alternatively comprise other snake shaft or flex shaft designs without departing from the scope of the disclosure. For example, suitable alternative forms of the articulation joint1102 are described in U.S. Pat. No. 9,232,979 to Parihar et al., U.S. Pat. No. 8,685,020 to Weizman et al., U.S. Pat. No. 8,262,563 to Bakos et al., U.S. Pat. No. 8,403,945 to Whitfield et al., and U.S. Patent Pub. 2007/0084897 to Shelton, IV et al., the contents of which are hereby incorporated by reference.
• As illustrated, the articulation joint1102 may include adistal connector1104a,aproximal connector1104b,and a plurality ofarticulation links1106 capable of being interconnected to extend between the distal andproximal connectors1104a,b.Thedistal connector1104amay be configured to couple the articulation joint1102 to the end effector604 (FIG. 11A), and theproximal connector1104bmay be configured to couple the articulation joint1102 to the distal end of the shaft602 (FIG. 11A). WhileFIG. 11B depicts fourteenarticulation links1106, the articulation joint1102 could alternatively include more or less than fourteenarticulation links1106, without departing from the scope of the disclosure.
• The articulation links1106 are interconnectable in series to cooperatively form theflexible shaft length1103. To accomplish this, eacharticulation link1106 may provide or otherwise define a pair oflobes1108 at one axial end and a corresponding pair ofrecesses1110 at the opposite axial end. To interconnect thearticulation links1106, thelobes1108 of the moreproximal articulation links1106 are received within or at therecesses1110 of the moredistal articulation links1106. It will be appreciated, however, that thearticulation links1106 may alternatively be arranged in reverse where thelobes1108 of the moredistal articulation links1106 would be received within therecesses1110 of the moreproximal articulation links1106, without departing from the scope of the disclosure. A mechanical fastener (not shown), such as a pin or the like, may be used to couple theadjacent articulation links1106 at the intersection of the corresponding lobes and recesses1108,1110. The mechanical fastener may allow relative (but limited) rotational movement between theadjacent articulation links1106 about an articulation axis A₃defined through each pair oflobes1108 as interconnected with a corresponding pair ofrecesses1110.
• The distal-most articulation link1106amay be coupled to aproximal end1112aof thedistal connector1104a,and theproximal-most articulation link1106bmay be coupled to the distal end1112bof theproximal connector1104b.More specifically, thelobes1108 of the distal-most articulation link1106amay be received into corresponding recesses1114 (one visible) provided on thedistal connector1104a,and therecesses1110 of theproximal-most articulation link1106bmay receive correspondinglobes1116 provided by theproximal connector1104b.Similar to the interconnection of thearticulation links1106, a mechanical fastener may be used to couple the distal-most articulation link1106ato thedistal connector1104a,and couple theproximal-most articulation link1106bto theproximal connector1104b.The mechanical fastener may or may not allow relative movement (rotation) between the adjacent component parts.
• The articulation joint1102 also includes one or more articulation cables, shown as afirst articulation cable1118aand asecond articulation cable1118b.Thearticulation cables1118a,bare actuatable to move the articulation joint1102 in at least one plane of motion. Thearticulation cables1118a,bextend from the drive housing608 (FIG. 11A), where they may be operatively coupled to one or more drive inputs operable to facilitate longitudinal translation of thearticulation cables1118a,band thereby cause articulation of the articulation joint1102. Thearticulation cables1118a,bmay extend along the entire axial length of the articulation joint1102 and may terminate at thedistal connector1104awith a pair ofcable connectors1120.
• Thearticulation cables1118a,bmay be operatively coupled to some or all of thearticulation links1106 as they extend along the axial length of the articulation joint1102. In some embodiments, for example, thearticulation cables1118a,bmay be threaded to/through some or all of thearticulation links1106. More specifically, thearticulation cables1118a,bmay pass through opposingcable paths1122 provided on angularly opposite sides of eacharticulation link1106. When the articulation joint1102 is assembled, thecable paths1122 of eacharticulation link1106 may axially align such that thearticulation cables1118a,bcan pass therethough in a relatively direct course. Thearticulation cables1118a,bare not bound within thecable paths1122, thereby allowing thearticulation cables1118a,bto axially translate relative to thearticulation links1106 during operation, which facilitates articulation of the articulation joint1102 in at least one plane of motion.
• Having the twoarticulation cables1118a,barranged on angularly opposite sides of the articulation links1106 allows thearticulation cables1118a,bto move the articulation joint1102 in a single plane of motion, such as left-to-right or “yaw” motion. For example, when the articulation joint1102 is assembled as described above, providing tension (pulling) on thefirst articulation cable1118aand simultaneously slackening thesecond articulation cable1118bmay result in the articulation joint1102 articulating in a first direction B₁. In contrast, providing tension (pulling) on thesecond articulation cable1118band simultaneously slackening thefirst articulation cable1118amay result in the articulation joint1102 articulating in a second direction B₂, opposite the first direction B₁.
• The articulation joint1102 may also be configured to move in a second plane of motion; i.e., up-and-down or “pitch” motion. To accomplish this, the elongate shaft602 (FIG. 11A) may first be rotated 90° about the longitudinal axis A₁, such as by rotating thehelical drive gear1004 and corresponding drivengear1006 ofFIG. 10. As will be appreciated, rotating theelongate shaft602 about the longitudinal axis A₁allows the articulation joint1102 to be articulated in an unlimited number of planes.
• In embodiments where the articulation joint1102 does not include thearticulation links1106 coupled at correspondinglobes1108 andrecesses1110, however, an additional two articulation cables (not shown) may be included in the articulation joint1102 and angularly offset from the first andsecond articulation cables1118a,bby 90° about the periphery of eacharticulation link1106. Providing tension (pulling) on one of the additional articulation cables while simultaneously slackening the other of the additional articulation cables will articulate the articulation joint1102 in pitch.
• When interconnected, thearticulation links1106 provide or otherwise define a lumen that extends along the entire length of the articulation joint1102. As described herein, a plurality ofsurgical clips1124 may be arranged or arrangeable in series within the lumen to be fed distally toward the end effector604 (FIG. 11A). As illustrated, thesurgical clips1124 may be arranged in series such that thelegs1126 of the more proximalsurgical clips1124 engage at or near thecrown1128 of the more distalsurgical clips1124. While thesurgical clips1124 are depicted as arranged with thelegs1126 leading the correspondingcrowns1128 in the distal direction, it is equally contemplated herein to have thesurgical clips1124 arranged in reverse order, where thecrown1128 of eachsurgical clip1124 leads in the distal direction.
• In some embodiments, a feedbar1130 (alternately referred to as a “clip pusher”) may be used to push the series ofsurgical clips1124 through the lumen of the articulation joint1102. Thefeedbar1130 may extend from the drive housing608 (FIG. 11A) where it may be operatively coupled to one or more drive inputs operable to facilitate longitudinal translation of thefeedbar1130. In such embodiments, the drive input(s) may be selectively actuated to advance the feedbar1130 (and, therefore, the surgical clips1124) a predetermined distance. In other embodiments, however, thefeedbar1130 may be operatively coupled to another type drive mechanism arranged proximal to the articulation joint1102 but distal to thedrive housing608. Thefeedbar1130 may be rigid enough to provide an axial load on thesurgical clips1124, but flexible enough such that thefeedbar1130 is able to flex or bend when the articulation joint1102 articulates during operation.
• In other embodiments, however, thefeedbar1130 may be omitted and thesurgical clips1124 may instead be advanced through the articulation joint1102 with another type of clip advancing device or mechanism. For example, in at least one embodiment, a biasing device (e.g., a spring or spring loaded feeder shoe) may be incorporated into the articulation joint1102 to selectively advance thesurgical clips1124 toward the end effector604 (FIG. 11A). In such embodiments, the biasing device may or may not have an indexible feeder shoe, as known in the art.
• FIG. 11C is a cross-sectional side view of the assembled articulation joint1102, according to one or more embodiments. As illustrated, thearticulation links1106 are interconnected and thearticulation cables1118a,bare operatively coupled to (e.g., threaded through) eacharticulation link1106 and terminate at thedistal connector1104a,as generally described above. Moreover, the articulation joint1102 is shown in a first or unarticulated state, where the articulation joint1102 extends generally straight and otherwise coaxial with the longitudinal axis A₁(FIGS. 6 and 11A) of theshaft602.
• As also illustrated, the assembledarticulation links1106 provide or otherwise cooperatively define alumen1132 that extends along the entire length of the articulation joint1102. Thesurgical clips1124 may be arranged in series within thelumen1132 and thefeedbar1130 is positioned proximal to thesurgical clips1124 and poised to advance thesurgical clips1124 distally. In some embodiments, thesurgical clips1124 may be stored within thelumen1132 until needed, but may alternatively be stored proximal to the articulation joint1102 and advanced distally with thefeedbar1130 when needed.
• In some embodiments, as illustrated, the articulation joint1102 may further include aretention member1134 positioned at or near the distal end of the articulation joint1102. In some embodiments, theretention member1134 may be configured to engage the distal-mostsurgical clip1124aand thereby prevent the serially-arranged (stacked)surgical clips1124 from advancing distally until the axial load provided by thefeedbar1130 overcomes the retentive forces provided by theretention member1134. Accordingly, theretention member1134 may operate as an indexing mechanism to sequentially feed individualsurgical clips1124 to the end effector604 (FIG. 11A).
• In some embodiments, theretention member1134 may comprise a passive biasing device, such as a gate spring or the like. In such embodiments, the spring force of theretention member1134 may be sufficient to retain the stackedsurgical clips1124 in place, but may be overcome when thefeedbar1130 applies a sufficiently large axial load on the stackedsurgical clips1124. In other embodiments, however, theretention member1134 may comprise an actuatable device configured to retain the stackedsurgical clips1124 in place and selectively release the distal-mostsurgical clip1124awhen actuated. In such embodiments, theretention member1134 may be actuated and otherwise driven using any of the actuation components associated with thedrive housings206,608 (FIGS. 2 and 6, respectively) discussed herein, or alternatively may be operatively coupled to a cable-driven worm gear or the like arranged near the articulation joint1102.
• In yet other embodiments, in addition to preventing the stackedsurgical clips1124 from advancing distally, or alternatively, theretention member1134 may be configured to rotate thesurgical clips1124 to a predetermined orientation before theclips1124 are fed into theend effector604.
• FIG. 11D is another cross-sectional side view of the assembled articulation joint1102, according to one or more embodiments. The articulation joint1102 is shown inFIG. 11D as having moved from the unarticulated state ofFIG. 11C to a second or articulated state. As used herein, “articulated state” refers to any position or orientation of the articulation joint1102 that places the end effector604 (FIG. 11A) off-axis from the longitudinal axis A₁(FIG. 11A) of the shaft602 (FIG. 11A). To transition the articulation joint1102 to the depicted articulated state, a tensile load may be applied on thesecond articulation cable1118bin the proximal direction C₁, while thefirst articulation cable1118ais simultaneously slackened in the distal direction C₂. In contrast, to transition the articulation joint1102 to an opposed articulated state in the same plane, a tensile load may be applied on thefirst articulation cable1118awhile simultaneously slackening thesecond articulation cable1118b.The rotatablyinterconnected articulation links1106 allow the articulated joint1102 to flex (bend) as the articulation cables118a,bare oppositely actuated.
• Unlike conventional flex shaft designs and applications, the articulation joint1102 may be capable of storing and/or conveying thesurgical clips1124 through thelumen1132 defined by thearticulation links1106 while the articulation joint1102 is in the unarticulated or articulated states. This advantage allows thesurgical clips1124 to be stored efficiently without interfering with the articulation joint1102, and also allows for increased articulation with fine manipulation. Thesurgical clips1124, however, must remain straight and otherwise non-deformed while the articulation joint1102 articulates and/or as thesurgical clips1124 are fed distally through the articulation joint1102. According to embodiments of the present disclosure, the articulation joint1102 may provide or otherwise define a clip track configured to receive and guide thesurgical clips1124 through the articulation joint1102. As described herein, the clip track may provide a pathway for thesurgical clips1124 to advance distally when the articulation joint is in the unarticulated or articulated states. When the articulation joint1102 is in the articulated state, the clip track may be necessary to help guide thesurgical clips1124 through a tortuous path provided by the articulation joint1102.
• FIG. 12 is a cross-sectional end view of a portion of the articulation joint1102, according to one or more embodiments. More specifically,FIG. 12 is a cross-sectional end view of anexample articulation link1106. In embodiments where the articulation joint1102 does not includearticulation links1106, however, but instead comprises an elongate structure defining a plurality of recesses or comprises a flexible or bendable shaft section,FIG. 12 may depict a cross-sectional end view at any location along the axial length of the articulation joint1102. For purposes of the present discussion, however,FIG. 12 will be described in conjunction with a cross-sectional end view of anexample articulation link1106. But it will be appreciated that the following description can equally be applied to alternative designs of the articulation joint1102, without departing from the scope of the disclosure.
• As illustrated, the articulation joint1102 is generally cylindrical in shape and defines or otherwise provides thelumen1132 that extends along the entire axial length of the articulation joint1102. In other embodiments, however, the articulation joint1102 may exhibit other cross-sectional shapes, such as polygonal (e.g., square) or ovoid, without departing from the scope of the disclosure. The first andsecond articulation cables1118a,bare shown extending throughcorresponding cable paths1122 located on angularly opposite positions of the articulation joint1102. In other embodiments, thecable paths1122 may be located external to the articulation joint1102 and otherwise coupled to the exterior thereof, without departing from the scope of the disclosure.
• A cross-sectional end view of an examplesurgical clip1124 is also depicted inFIG. 12. In the illustrated embodiment, at least a portion of thesurgical clip1124 is received within aclip track1202 defined in the inner wall of thelumen1132. Theclip track1202 may be configured to support and guide thesurgical clips1124 within thelumen1132 as they advance distally through the articulation joint1102. Moreover, theclip track1202 may help thesurgical clips1124 navigate through the single plane articulation joint1102 by guiding theclips1124 perpendicular to the bend direction. Consequently, theclip track1202 helps align thesurgical clips1124 with the bend direction, which allows for higher curvature potential of the articulation joint1102.
• To accomplish this, theclip track1202 may include opposing side rails1204 (alternately referred to as “slots”) defined on angularly opposite sides of thelumen1132 and configured to receive and support corresponding portions of thesurgical clips1124. In some embodiments, as illustrated, the cross-sectional shape of the side rails1204 may be polygonal (e.g., square or rectangular), but could alternatively be arcuate or ovoid in shape, without departing from the scope of the disclosure. In any event, the side rails1204 may be shaped to receive and allow thesurgical clips1124 to slide therein as they advance distally within thelumen1132.
• In some embodiments, theclip track1202 may twist or provide a helical path for thesurgical clips1124. In such embodiments, thesurgical clips1124 may enter the articulation joint1102 in a vertical alignment, and the side rails1204 may provide a helical path along the length of the articulation joint1102 such that thesurgical clips1124 exit the articulation joint1102 in a horizontal alignment. This may prove advantageous in embodiments where thejaw members610,612 (FIG. 11A) are horizontally-oriented, but thesurgical clips1124 are stored proximal to the end effector604 (FIG. 11A) in a vertical orientation.
• FIGS. 13A-13E are cross-sectional top views of the articulation joint1102, as taken along the line indicated inFIG. 12. InFIG. 13A, thesurgical clip1124 is depicted within thelumen1132 and supported by theclip track1202. More specifically, thelegs1126 of thesurgical clip1124 are at least partially received into the opposingside rails1204 and thecrown1128 is generally centered within thelumen1132.
• InFIG. 13B, thesurgical clip1124 includes or otherwise provides clip posts ortabs1302 that extend laterally from eachleg1126. Theclip tabs1302 may be configured to extend into or otherwise be received within the opposingside rails1204 of theclip track1202. Theclip tabs1302 operate to support thesurgical clip1124 within thelumen1132 and slidably engage theside rails1204 as thesurgical clip1124 advances within theclip track1202. At least one advantage to usingsurgical clips1124 with theclip tabs1302 is that the clips are more readily pivotable about the tabs, allowing for the highest attainable articulation of the clip without bending or pre-forming the clip in any way (as opposed to an entire length of a leg being captured in the curved track).
• InFIG. 13C, thesurgical clip1124 is generally pear-shaped and has opposingshoulders1304 defined on eachleg1126. Theshoulders1304 may comprise bends in thelegs1126 that are configured to extend into or otherwise be received within the opposingside rails1204 of theclip track1202. Similar to theclip tabs1302 ofFIG. 13B, theshoulders1304 may operate to support thesurgical clip1124 within thelumen1132 and slidably engage theside rails1204 as thesurgical clip1124 advances within theclip track1202.
• In some embodiments, thesurgical clip1124 is received within theclip track1202 via an interference fit that elastically flexes the legs inward and results in thesurgical clip1124 assuming the pear-shaped configuration. Upon exiting the confines of thelumen1302, thelegs1126 may be able to flex and open fully. In other embodiments, however, thesurgical clip1124 may be naturally in the pear-shaped configuration. In such embodiments, the articulation joint1102 may include a device or mechanism configured to receive the pear-shapedsurgical clips1124 from thelumen1132 and re-form it to a shape ready for crimping. At least one advantage to using pear-shapedsurgical clips1124 is minimizing the diameter of thelumen1132, which can minimize the size (diameter) of the end effector604 (FIG. 11A). Moreover, the pear-shapedclips1124 may also prove advantageous in providing small and tight packing (stacking).
• InFIG. 13D, thesurgical clip1124 is generally V-shaped and thelegs1126 may be angled toward the inner wall of thelumen1132. Thelegs1126 extend into and are otherwise received by the opposingside rails1204 of theclip track1202, and theangled legs1126 operate to support thesurgical clip1124 within thelumen1132 and slidably engage thecorresponding side rails1204 as thesurgical clip1124 advances distally within the articulation joint1102.
• At least one advantage to the V-shapedsurgical clips1124 is the ability to stack thesurgical clips1124 in a nested arrangement where thelegs1126 of the more proximalsurgical clips1124 extend past thecrown1128 of the more distal-surgical clips1124. This nested arrangement allows moresurgical clips1124 to be stacked together in contrast to typical clip stacking arrangements where thelegs1126 of the more proximalsurgical clips1124 engage thecrown1128 of the more distal-surgical clips1124.
• InFIG. 13E, thesurgical clip1124 is generally W-shaped. Thelegs1126 may be angled toward the inner wall of thelumen1132, and thecrown1128 may provide an undulating section. Thelegs1126 extend into and are otherwise received by the opposingside rails1204 of theclip track1202. Theangled legs1126 operate to support thesurgical clip1124 within thelumen1132 and slidably engage thecorresponding side rails1204 as thesurgical clip1124 advances distally within the articulation joint1102. At least one advantage to the W-shapedsurgical clip1124 is that the undulatingcrown1128 provides additional surfaces and/or structure to engage with the feedbar1130 (FIG. 11B). In addition, the W-shapedsurgical clip1124 provides a similar ability to stack in a nested arrangement as the V-shapedclip1128 ofFIG. 13D, thus allowing more surgical clips to be stacked together.
• FIG. 14A is a cross-sectional side view of another example articulation joint1402, according to one or more embodiments of the present disclosure. The articulation joint1402 may be similar in some respects to the articulation joint1102 ofFIGS. 11A-11D and, therefore, may be best understood with reference thereto. Similar to the articulation joint1102, for example, the articulation joint1402 may comprise aflexible shaft length1403 that defines alumen1404 extending along the axial length of the articulation joint1402. Thelumen1404 may be configured to house and/or convey a plurality ofsurgical clips1124 therethrough to be received at the end effector604 (FIG. 11A) for crimping. Accordingly,surgical clips1124 can be stored within theflexible shaft length1403 and/or proximal thereto and advanced distally through the articulation joint1402 to be received between thejaw members610,612 (FIG. 11A).
• Moreover, similar to the articulation joint1102 ofFIGS. 11A-11D, the articulation joint1402 may include thearticulation cables1118a,boperatively coupled to theflexible shaft length1403 to cause articulation thereof in at least one plane of motion. In the illustrated embodiment, thearticulation cables1118a,bare located on angularly opposite positions of the flexible shaft length1403 (e.g., 180° offset) and extend along all or a portion of the axial length thereof. In some embodiments, thearticulation cables1118a,bmay extend through the sidewall of theflexible shaft length1403. More specifically, thearticulation cables1118a,bmay be threaded through corresponding and opposingcable paths1122 formed or otherwise provided on angularly opposite sides of theflexible shaft length1403. In other embodiments, however, thearticulation cables1118a,bmay be operatively coupled to the exterior of theflexible shaft length1403. In such embodiments, thecable paths1122 may be located external to theflexible shaft length1403 and otherwise coupled to the exterior thereof.
• Thearticulation cables1118a,bmay or may not be bound within thecable paths1122. Moreover, in some embodiments, more than the two depictedarticulation cables1118a,bmay be employed to allow the articulation joint1402 to articulate in multiple planes of motion.
• Unlike the articulation joint1102 ofFIGS. 11A-11D, however, the articulation joint1402 may be made of a flexible material that allows the articulation joint1402 to transition between unarticulated and articulated states in one or more planes of motion as acted upon by thearticulation cables1118a,b.Suitable flexible materials include, but are not limited to, a rubber (e.g., silicone rubber), a flexible plastic, an elastomer, nylon, spandex/lycra, and any combination thereof. In other embodiments, the flexible material may comprise a laser cut metal tube (that is one piece), which can flex like lower modulus materials. In yet other embodiments, the flexible material may comprise a woven metal or plastic sheath or jacketing.
• The articulation joint1402 may further provide or otherwise define aclip track1406 configured to receive and guide thesurgical clips1124 through thelumen1404. Theclip track1406 may provide a pathway for thesurgical clips1124 when the articulation joint1402 is in the unarticulated or articulated states. When the articulation joint1402 is in the articulated state, theclip track1406 may be necessary to help guide thesurgical clips1124 through a tortuous path provided by the articulation joint1402. Accordingly, theclip track1406 may prove advantageous in helping thesurgical clips1124 navigate through the single plane articulation joint1402 by guiding theclips1124 perpendicular to the bend direction.
• In the illustrated embodiment, theclip track1406 comprises opposingguide rails1408 arranged within thelumen1404. Theguide rails1408 may be offset from each other and otherwise cooperatively define aclip passageway1410 configured to receive and guide thesurgical clips1124 therein as they traverse the articulation joint1402. As illustrated, thesurgical clips1124 are arranged in series within theclip passageway1410. In some embodiments, theguide rails1408 may be attached to the inner wall of thelumen1404 at one or more locations. The number of attachment points may directly correlate to the flexibility of theguide rails1408 relative to the lumen1404 (e.g., more contact points =less flex, less contact points =more flex). In other embodiments, theguide rails1408 may be attached at the proximal and distal ends of the articulation joint1402.
• Theguide rails1408 may be made of a flexible material, such as any of the flexible materials mentioned herein. This allows theclip track1406 to correspondingly flex in response to movement (articulation) of theflexible shaft length1403. Theguide rails1408 may be positioned within thelumen1404 such that theclip passageway1410 widens within a single plane to allow the surgical clips to align with the bend direction of the articulation joint1402. Moreover, theguide rails1408 may be positioned within thelumen1404 such that theclip passageway1410 becomes progressively wider near the point of maximum bend, such that thesurgical clips1124 are then capable of translating and rotating around said bend without binding at their distal or proximal ends.
• The articulation joint1102 is shown inFIG. 14A in a first or unarticulated state, where the articulation joint1402 extends generally straight and otherwise coaxial with the longitudinal axis A₁(FIGS. 6 and 11A) of theshaft602.
• FIG. 14B is another cross-sectional side view of the articulation joint1402, according to one or more embodiments. The articulation joint1402 is shown inFIG. 14B as having moved from the unarticulated state ofFIG. 14A to a second or articulated state. To transition the articulation joint1402 to the depicted articulated state, a tensile load may be applied on thesecond articulation cable1118bin the proximal direction C₁, while thefirst articulation cable1118ais simultaneously slackened in the distal direction C₂. In contrast, to transition the articulation joint1402 to an opposed articulated state in the same plane, a tensile load may be applied on thefirst articulation cable1118awhile simultaneously slackening thesecond articulation cable1118b.The flexible material allows the articulated joint1402 to flex (bend) as the articulation cables118a,bare oppositely actuated.
• As the articulation joint1402 is moved to the articulated position, theguide rails1408 flex and widen within a single plane perpendicular to the bend direction of the articulation joint1402. As illustrated, the size of theclip passageway1410 increases to accommodate the bend in theflexible shaft length1403 and also to accommodate the axially-extendingsurgical clips1124 as they traverse the tortuous path resulting from movement of theflexible shaft length1403. As will be appreciated, this may prove advantageous in allowing thesurgical clips1124 to be fed distally within theclip track1406 when the articulated joint1402 is articulated in either direction. Moreover, theclip track1406 helps align thesurgical clips1124 with the bend direction, which allows for higher curvature potential of the articulation joint1402.
• FIG. 15A is a side view of another example articulation joint1502, according to one or more embodiments of the present disclosure. The articulation joint1502 may be similar in some respects to the articulation joints1102 and1402 ofFIGS. 11A-11D and 14A-14B, respectively and, therefore, may be best understood with reference thereto. Similar to the articulation joints1102 and1402, for example, the articulation joint1502 may comprise aflexible shaft length1503 that defines a lumen that extends along its axial length. A plurality ofsurgical clips1124 may be housed within and/or conveyed through the lumen to be received at theend effector604 for crimping. Accordingly,surgical clips1124 can be stored within theflexible shaft length1503 and/or proximal thereto and advanced distally through the articulation joint1502 with thefeedbar1130 to be received between thejaw members610,612.
• Similar to the articulation joint1102 ofFIGS. 11A-11D, the articulation joint1502 may include a plurality ofarticulation links1504 that may be interconnectable in series to cooperatively form theflexible shaft length1503. In other embodiments, however, theflexible shaft length1503 may alternatively comprise a continuous shaft length made of a flexible material.
• Furthermore, similar to the articulation joint1102 and1402 ofFIGS. 11A-11D and 14A-14B, respectively, the articulation joint1502 may include thearticulation cables1118a,boperatively coupled to theflexible shaft length1503 to cause bending or flexing articulation thereof. In the illustrated embodiment, thearticulation cables1118a,bare located on angularly opposite sides of theflexible shaft length1503 and extend along all or a portion of the axial length thereof. In some embodiments, thearticulation cables1118a,bmay extend through thearticulation links1504, such as being threaded through eacharticulation link1504 in corresponding cable paths (e.g., thecable paths1122 ofFIG. 11A).
• To transition the articulation joint1502 to the depicted articulated state, a tensile load may be applied on thesecond articulation cable1118bin the proximal direction C₁, while thefirst articulation cable1118ais simultaneously slackened in the distal direction C₂. In contrast, to transition the articulation joint1502 to an opposed articulated state in the same plane, a tensile load may be applied on thefirst articulation cable1118awhile simultaneously slackening thesecond articulation cable1118b.
• The articulation joint1502 may further include a clip track provided or otherwise defined within the lumen that helps guide thesurgical clips1124 toward theend effector604. In the present embodiment, the clip track may be configured to twist or provide a helical path for thesurgical clips1124 to traverse along at least a portion of the articulation joint1502. In some embodiments, for example, thesurgical clips1124 may enter the articulation joint1502 in a vertical orientation and the clip track may provide a helical path that alters the orientation of thesurgical clips1124 such that thesurgical clips1124 exit the articulation joint1502 in a horizontal alignment. Accordingly, the clip track may be configured to receivesurgical clips1124 in a first angular orientation, and discharge the surgical clips in a second angular orientation, where the second angular orientation is 90° offset from the first angular orientation. As will be appreciated, this may prove advantageous in applications where thesurgical clips1124 are stored in a vertical orientation, but thejaw members610,612 are arranged in a horizontal orientation. In such applications, the clip track may properly orient thesurgical clips1124 to be aligned with thejaw members610,612.
• FIG. 15B is a shortened side view of at least a portion of the articulation joint1502 ofFIG. 15A, according to one or more embodiments of the present disclosure. It is noted that the entire axial length of the articulation joint1502 is not drawn to scale inFIG. 15B. Rather, for simplicity the length has been shortened for the present discussion.
• As illustrated, theflexible shaft length1503 comprises a generally cylindrical body having aproximal end1510aand adistal end1510b opposite theproximal end1510a.In some embodiments, theflexible shaft length1503 may comprise theinterconnected articulation links1504 ofFIG. 15A, but could alternatively comprise a continuous shaft length made of a flexible material, as mentioned above. Alumen1512 may be defined within theflexible shaft length1503 and extends between the proximal anddistal ends1510a,b.
• Aclip track1514 may be provided or otherwise defined by the articulation joint1502 within thelumen1512 and may extend between the proximal anddistal ends1510a,b.Theclip track1514 may be defined into the inner wall of theflexible shaft length1503 and may comprise opposingside rails1516 sized to receive a portion of thesurgical clips1124. For example, in some embodiments, the side rails1516 may be configured to receive thelegs1126 of thesurgical clips1124. However, any of the configurations shown and described with reference toFIGS. 13A-13E may equally apply to this embodiment.
• The side rails1516 may extend distally in a corresponding curved or helical pathway between the proximal anddistal ends1510a,b.The helical pathway may be configured to transition the orientation of thesurgical clips1124 90° as they traverse the articulation joint1502. Accordingly, asurgical clip1124 oriented entering the articulation joint1502 in a vertical orientation at theproximal end1510awill be transitioned to a horizontal orientation upon traversing theclip track1514 and exiting the articulation joint1502 at thedistal end1510b.
• In some embodiments, theclip track1514 may be defined along only a portion of theflexible shaft length1503. In such embodiments, thesurgical clips1124 may be conveyed at least partially through theflexible shaft length1503 until encountering theclip track1514. Thesurgical clips1124 may then be fed into theclip track1514 in a first angular orientation, and exit theclip track1514 at a second angular orientation that is 90° offset from the first angular orientation. In other embodiments, however, theclip track1514 may alternatively be provided by an entirely separate structure arranged distal to the articulation joint1502, without departing from the scope of the disclosure.
• Embodiments disclosed herein include:
• A. A surgical clip applier that includes a drive housing, an elongate shaft that extends distally from the drive housing, an end effector arranged at a distal end of the elongate shaft and including first and second jaw members, and an articulation joint interposing the end effector and the elongate shaft. The articulation joint includes a flexible shaft length articulable in a plane of motion and having a first end and a second end, a lumen defined within the flexible shaft length and extending between the first and second ends, and a clip track provided within the lumen and extending at least partially between the first and second ends to guide surgical clips through the articulation joint to be received by the first and second jaw members for crimping.
• B. A method of operating a surgical clip applier that includes positioning the surgical clip applier adjacent a patient for operation, the surgical clip applier including a drive housing, an elongate shaft that extends distally from the drive housing, an end effector arranged at a distal end of the elongate shaft and including first and second jaw members, and an articulation joint interposing the end effector and the elongate shaft. The articulation joint includes a flexible shaft length articulable in a plane of motion and having a first end and a second end, a lumen defined within the flexible shaft length and extending between the first and second ends, and a clip track provided within the lumen and extending at least partially between the first and second ends. The method further includes articulating the flexible shaft length in the plane of motion between an unarticulated state and an articulated state, advancing one or more surgical clips through the lumen with the flexible shaft length in the unarticulated state or the articulated state, guiding the one or more surgical clips through the articulation joint with the clip track, receiving a distal-most surgical clip of the one or more surgical clips from the articulation joint with the first and second jaw members, and collapsing the first and second jaw members to crimp the distal-most surgical clip.
• Each of embodiments A and B may have one or more of the following additional elements in any combination: Element1: wherein the clip track extends perpendicular to the plane of motion. Element2: wherein the clip track provides opposing side rails defined on angularly opposite sides of the lumen and a portion of each surgical clip is receivable within and supported by the opposing side rails. Element3: wherein the portion of each surgical clip slidably engages the opposing side rails as each surgical clip advances distally within the clip track. Element4: wherein the clip track provides a helical path such that the surgical clips enter the flexible shaft length joint in a first angular orientation and exit the articulation joint in a second angular orientation angularly offset from the first angular orientation. Element5: further comprising one or more articulation cables extending from the drive housing and operatively coupled to the flexible shaft length, wherein the one or more articulation cables are actuatable to move the articulation joint in the plane of motion. Element6: wherein the flexible shaft length comprises a plurality of articulation links interconnected in series and extending between the first and second ends, and wherein the plurality of articulation links cooperatively define the lumen. Element7: wherein the flexible shaft length is made of a flexible material that allows the articulation joint to bend in the plane of motion. Element8: further comprising a feedbar movable within the lumen to advance the surgical clips distally through the clip track. Element9: further comprising biasing device arrangeable within the lumen to advance the surgical clips distally through the clip track. Element10: wherein the articulation joint further comprises a retention member arranged at or near the distal end of the flexible shaft length to index the surgical clips. Element11: wherein the retention member comprises a passive biasing device. Element12: wherein the flexible shaft length is articulable between an unarticulated state and an articulated state, and wherein the surgical clips traverse the articulation joint when the flexible shaft is in the unarticulated and articulated states. Element13: wherein the clip track comprises opposing guide rails offset from each other to cooperatively define a clip passageway that receives and guides the surgical clips through the articulation joint. Element14: wherein the opposing guide rails are made of a flexible material and a size of the clip passageway increases when the flexible shaft length articulates.
• Element15: wherein the clip track provides opposing side rails defined on angularly opposite sides of the lumen, and wherein guiding the one or more surgical clips through the articulation joint with the clip track comprises receiving a portion of each surgical clip within the opposing side rails. Element16: further comprising slidably engaging the portion of each surgical clip within the opposing side rails as each surgical clip advances distally within the clip track. Element17: wherein the clip track provides a helical path, the method further comprising introducing the one or more surgical clips into the flexible shaft length in a first angular orientation, and discharging the one or more surgical clips from the flexible shaft length in a second angular orientation angularly offset from the first angular orientation. Element18: wherein advancing the one or more surgical clips through the lumen comprises advancing the one or more surgical clips distally through the clip track with a feedbar movable within the lumen. Element19: wherein the clip track comprises opposing guide rails made of a flexible material and offset from each other to cooperatively define a clip passageway, and wherein guiding the one or more surgical clips through the articulation joint comprises receiving and guiding the one or more surgical clips through the clip passageway, and increasing a size of the clip passageway when the flexible shaft length articulates to the articulated state.
• By way of non-limiting example, exemplary combinations applicable to A and B include: Element2 with Element3; Element2 with Element4; Element10 with Element11; Element13 with Element14; Element15 with Element16; and Element15 with Element17.
• Therefore, the disclosed systems and methods are well adapted to attain the ends and advantages mentioned as well as those that are inherent therein. The particular embodiments disclosed above are illustrative only, as the teachings of the present disclosure may be modified and practiced in different but equivalent manners apparent to those skilled in the art having the benefit of the teachings herein. Furthermore, no limitations are intended to the details of construction or design herein shown, other than as described in the claims below. It is therefore evident that the particular illustrative embodiments disclosed above may be altered, combined, or modified and all such variations are considered within the scope of the present disclosure. The systems and methods illustratively disclosed herein may suitably be practiced in the absence of any element that is not specifically disclosed herein and/or any optional element disclosed herein. While compositions and methods are described in terms of “comprising,” “containing,” or “including” various components or steps, the compositions and methods can also “consist essentially of” or “consist of” the various components and steps. All numbers and ranges disclosed above may vary by some amount. Whenever a numerical range with a lower limit and an upper limit is disclosed, any number and any included range falling within the range is specifically disclosed. In particular, every range of values (of the form, “from about a to about b,” or, equivalently, “from approximately a to b,” or, equivalently, “from approximately a-b”) disclosed herein is to be understood to set forth every number and range encompassed within the broader range of values. Also, the terms in the claims have their plain, ordinary meaning unless otherwise explicitly and clearly defined by the patentee. Moreover, the indefinite articles “a” or “an,” as used in the claims, are defined herein to mean one or more than one of the elements that it introduces. If there is any conflict in the usages of a word or term in this specification and one or more patent or other documents that may be incorporated herein by reference, the definitions that are consistent with this specification should be adopted.
• As used herein, the phrase “at least one of” preceding a series of items, with the terms “and” or “or” to separate any of the items, modifies the list as a whole, rather than each member of the list (i.e., each item). The phrase “at least one of” allows a meaning that includes at least one of any one of the items, and/or at least one of any combination of the items, and/or at least one of each of the items. By way of example, the phrases “at least one of A, B, and C” or “at least one of A, B, or C” each refer to only A, only B, or only C; any combination of A, B, and C; and/or at least one of each of A, B, and C.

Claims (20)

What is claimed is:

1. A surgical clip applier, comprising:

a drive housing;

an elongate shaft extending distally from the drive housing; and

an end effector arranged at a distal end of the shaft and including first and second jaw members, a cam slidably engageable with the first and second jaw members, and an actuation cable extending from the drive housing and operatively coupled to the cam; and

an articulation joint interposing the end effector and the shaft and including a distal clevis coupled to the end effector, a proximal clevis coupled to a distal end of the shaft, and a spacer interposing the distal and proximal clevises,

wherein longitudinal movement of the actuation cable moves the cam distally to collapse the first and jaw members.

2. The surgical clip applier ofclaim 1, wherein the end effector further comprises a pulley that receives and redirects the actuation cable for coupling with the cam.

3. The surgical clip applier ofclaim 1, wherein the actuation cable comprises a first actuation cable and the end effector further comprises a second actuation cable extending from the drive housing and operatively coupled to the cam,

wherein longitudinal movement of the first actuation cable moves the cam distally to collapse the first and second jaw members, and

wherein longitudinal movement of the second actuation cable moves the cam proximally and allows the first and second jaw members to open.

4. The surgical clip applier ofclaim 3, wherein a camming channel is defined in the cam and slidably receives cam tracks provided by the first and second jaw members, and wherein the camming channel pushes the first and jaw members together via the cam tracks as the cam is advanced distally.

5. The surgical clip applier ofclaim 1, wherein the spacer is rotatably coupled to the distal clevis at a first axle, and rotatably coupled to the proximal clevis at a second axle.

6. The surgical clip applier ofclaim 5, wherein a first pivot axis extends through the first axle and a second pivot axis extends through the second axle and is perpendicular to first pivot axis.

7. The surgical clip applier ofclaim 1, wherein the actuation cable extends through the articulation joint to be operatively coupled to the cam.

8. The surgical clip applier ofclaim 1, further comprising a plurality of drive cables extending through the articulation joint and operatively coupled to the end effector, wherein selective actuation of the plurality of drive cables causes the end effector to articulate relative to the shaft.

9. A method of operating a surgical clip applier, comprising:

positioning the surgical clip applier adjacent a patient for operation, the surgical clip applier including a drive housing, an elongate shaft extending distally from the drive housing, an end effector arranged at a distal end of the shaft and including:

first and second jaw members;

a cam slidably engageable with the first and second jaw members; and

an actuation cable extending from the drive housing and operatively coupled to the cam,

actuating the actuation cable from the drive housing and thereby longitudinally moving the actuation cable;

moving the cam distally and toward the first and second jaw members with the actuation cable; and

collapsing the first and second jaw members as the cam moves distally.

10. The method ofclaim 9, wherein collapsing the first and second jaw members comprises:

receiving a surgical clip between the first and second jaw members; and

crimping the surgical clip as the first and second jaw members collapse.

11. The method ofclaim 9, wherein the actuation cable comprises a first actuation cable and the end effector further comprises a second actuation cable extending from the drive housing and operatively coupled to the cam, the method further comprising:

longitudinally moving the first actuation cable and thereby advancing the cam distally to collapse the first and second jaw members;

longitudinally moving the second actuation cable and thereby moving the cam proximally; and

opening the first and second jaw members as the cam moves proximally.

12. The method ofclaim 9, wherein a camming channel is defined in the cam to slidably receive cam tracks provided by the first and second jaw members, the method further comprising pushing the first and jaw members together with the camming channel via the cam tracks as the cam is advanced distally.

13. The method ofclaim 12, further comprising an articulation joint interposing the end effector and the shaft, the articulation joint including a distal clevis coupled to the end effector, a proximal clevis coupled to a distal end of the shaft, and a spacer interposing the distal and proximal clevises, the method further comprising:

rotatably coupling the spacer to the distal clevis at a first axle; and

rotatably coupling the spacer to the proximal clevis at a second axle orthogonal to the first axle.

14. The method ofclaim 13, where in the end effector further comprises a plurality of drive cables extending through the articulation joint and operatively coupled to the end effector, the method further comprising actuating the plurality of drive cables and thereby articulating the end effector relative to the shaft.

15. An end effector, comprising:

first and second jaw members;

a cam slidably engageable with the first and second jaw members; and

an actuation cable operatively coupled to the cam such that longitudinal movement of the actuation cable moves the cam distally to collapse the first and jaw members.

16. The end effector ofclaim 15, further comprising a pulley that receives and redirects the actuation cable for coupling with the cam.

17. The end effector ofclaim 15, wherein the actuation cable comprises a first actuation cable and the end effector further comprises a second actuation cable operatively coupled to the cam,

wherein longitudinal movement of the first actuation cable moves the cam distally to collapse the first and second jaw members, and

wherein longitudinal movement of the second actuation cable moves the cam proximally and allows the first and second jaw members to open.

18. The end effector ofclaim 17, wherein a camming channel is defined in the cam to slidably receive cam tracks provided by the first and second jaw members, and wherein the camming channel pushes the first and jaw members together via the cam tracks as the cam is advanced distally.

19. The end effector ofclaim 15, further comprising an articulation joint operatively coupled to the end effector and comprising:

a distal clevis coupled to the end effector;

a spacer rotatably coupled to the distal clevis at a first axle; and

a proximal clevis rotatably coupled to the spacer at a second axle,

wherein the actuation cable extends through the articulation joint to be operatively coupled to the cam.

20. The end effector ofclaim 19, further comprising a plurality of drive cables extending through the articulation joint and operatively coupled to the end effector, wherein selective actuation of the plurality of drive cables causes the end effector to articulate relative to the shaft.

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